Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (11 page)

Mulderick’s first-floor command center was relocated to a fourth-floor nurse training room. Another concern was drug reserves. Memorial, like many modern hospitals, did not maintain a large supply of medications on hand, opting instead for a “just in time delivery” system.
The head pharmacist had requested an emergency cache of medicines from supplier McKesson on Saturday, but the company’s workers seemed to have already left their local warehouse ahead of the storm. They never delivered the drugs. Now, Monday morning, only about a day’s worth of certain medicines remained. Memorial would need more supplies by Tuesday morning.

Memorial CEO René Goux was on-site and asked his community relations manager, Sandra Cordray, to share these issues with corporate executives at Tenet Healthcare in Dallas.
“Rene’s major concern is patient care after storm and high flood waters and continued loss of power,” she wrote in an e-mail to Tenet’s chief operating officer and other officials.
“We will consider options for patient evacuation—that we may not have to use.”

Some patients were not being seen because their doctors were off-site and unreachable by phone. The medical staff president, Reuben L. Chrestman III, was on vacation. In his absence, Dr. Richard E. Deichmann, chairman of medical services, one of Memorial’s three clinical departments, took the lead in organizing the physicians. Most of them were, like Anna Pou, university doctors or private contractors credentialed to admit patients, but not employed by the hospital. Memorial didn’t specifically require most medical specialists to be present for hurricanes. These doctors had stayed either because they were on call for the weekend like Pou or had, like Dr. John Thiele, grown accustomed over years of hurricane warnings and near misses to spending storms in their offices.

More doctors seemed to be on hand than in any previous hurricane, perhaps because the storm had fallen on a weekend and those on call had simply stayed. Several, Deichmann and Baltz among them, were internists. Thiele was one of three lung specialists present who treated critically ill patients in the ICU. Others included a kidney specialist, an infectious diseases doctor, emergency medicine doctors, and neonatologists who took care of the youngest, sickest babies. There were several surgeons, including Pou, and three anesthesiologists. Deichmann assigned these clinical doctors to different nursing stations so that someone would be in charge of each of the fifteen patient units.

Katrina rapidly lost strength after moving onto land. The rain lessened and the winds began to ease by late morning. The water level outside Memorial stabilized at about three feet. Maintenance crews began to survey roof damage and broken windows, downed ceiling tiles, and sodden carpets that, in the growing heat, invited mold.

By midafternoon, the waters outside began to recede. Pets and food were carried back downstairs. Nurses mopped floors for hours until the rain and the ceiling leaks stopped completely. Patients tried to call loved
ones to check on them and let them know they had come through all right. Emmett Everett, the 380-pound patient up in LifeCare who had been moved from Chalmette in St. Bernard Parish,
was unable to reach his wife on her cell phone and told his nurse he was worried about her.

By evening, the flooding was gone, and it was possible to walk dogs outside. Some doctors who lived nearby navigated the debris-filled streets to check on their property and even stay the night at home. Other staff crossed back to their campsites in the new surgery building. Katrina had weakened before arrival, buffeting the city with only Category One or Two winds, not the Category Five tempests envisioned by the doom-prophesying weathermen. “We dodged a bullet,” people said to one another with weary relief. Memorial had sustained damage but remained functional on backup power. The hospital seemed to have weathered one more storm.

CHAPTER
4

DAY THREE
TUESDAY, AUGUST 30, 2005

“CODE BLUE, ER.”

Karen Wynn’s eyes opened in the dark room. She felt around for her shoes and socks, but could only find her teenage daughter’s flip-flops. She shoved them on her feet and ran the length of two city blocks from the new surgery building over the footbridge into the main hospital and down to the first-floor emergency room, struggling not to trip or cut her feet on broken glass.

Along the way, the ICU nurse manager tried to sort through her confusion. It had to be four or five in the morning. Why were they summoning her to a Code Blue in the emergency room? The ER staff members could resuscitate patients by themselves. Besides, who would be coming into the hospital when most of the city had been evacuated?

She arrived, panting. Blood was everywhere. A woman was lying on a gurney. She looked to be in her late sixties. The story came from her grandson, who had carried her up the ER ramp. There had been drinking. A fight. The woman’s daughter stabbed her in the chest with a kitchen knife. The grandson ran for help and found policemen, but they
told him there were no ambulances running and he would have to find some other way to get her to the hospital.

The knife-and-gun club hadn’t taken a break, even within hours of a major hurricane.

The page operator called overhead for all doctors to come to the emergency room. Internist Horace Baltz appeared in a white coat, with bare legs. In an effort to get there quickly, the senior doctor had thrown the coat on over his shorts, then tied on his black Oxford shoes and run downstairs.

The patient, at first conscious and communicative, began struggling to breathe. Wynn knew air might have followed the knife’s path into her chest and collapsed her lungs. The woman’s blood-pressure measurements were falling.

Blood could be collecting in the sac around her heart, constricting it and limiting its ability to fill and pump. Someone called for an ultrasound machine technician to check this, but for now there was no time to await answers. A doctor made a cut in the skin between two of the woman’s ribs, spread the tissues with a blunt instrument, and pushed a tube into her chest cavity to release any built-up air. Another tube went into her throat and was attached to a mechanical ventilator to help her breathe.

Fortunately, the ultrasound exam showed that the knife had not penetrated the membrane around the woman’s heart. Open-chest surgery wouldn’t be necessary. The team hadn’t liked the thought of attempting it on backup generator power. Wynn’s ICU had one available bed. The woman was taken by elevator to the eighth floor.

The ICU nurses on the overnight shift received their new patient at about six a.m. and began positioning the tangle of equipment that had taken over for many of her bodily systems. The machines breathed for her, checked her blood pressure at regular intervals, measured her pulse, pumped fluid into her veins, and monitored the oxygen level in her capillaries—all just as if a hurricane had never happened.

A nurse rolled a cart with a computer up to the woman’s bedside and began documenting her progress. Some of the ICU nurses had radios on their carts. They tuned them to
WWL, a popular 50,000-watt talk radio station that was broadcasting on generator power.

On the radio, the president of neighboring Jefferson Parish announced that
martial law had been declared. The hosts aired his message repeatedly, but martial law—an extremely rare assumption of police powers by the military typically requiring an act of Congress—had not, in fact, been declared in the disaster zone.

A caller complained that looters were ravaging New Orleans. She didn’t say how she knew this, but the radio host took her at her word and amplified her outrage to thousands of listeners. “If someone is breaking into businesses and looting merchandise, these people should be shot,” he said. “We’re under martial law here.”

Throughout the early morning, callers began describing something even more ominous. Water from the storm was still sitting in the streets. One resident was mystified because he could hear the city’s drainage pumps running.
“My question is,” he said to the host, “if you live a block away from the pumping station, and the pumping station is working, why would you have water in your house?” The host had no answer.

“We’re very frightened,” a man named Freddy said calmly, and described his situation. He was sitting in the attic of his home in the Gentilly neighborhood near Lake Pontchartrain, surrounded by about nine feet of water. The area, one of those that had flooded badly in the 1927 storm, was several miles northeast of Memorial. With him were four other people, including a baby. They had punched a hole through the roof and, using candles, a lantern, and a flashlight, had tried for four hours to signal a helicopter.

“And is the water rising anymore?” the host asked him.

“Yes, it’s steady rising, yes.”

“The water’s rising?” one nurse asked aloud in the medical ICU at Memorial. It made no sense. The street flooding around the hospital had
gone away. Anyone who had taken a break and ventured outside during the night knew it was clear and still. The news was confusing and worrisome, but there was work to do.

The sun rose, and around Memorial the streets remained dry. The sky outside the windows was blue. At seven a.m., after the stabbed patient was settled in, nurse manager Karen Wynn went downstairs to the relocated command center on the fourth floor for the day’s first meeting of the disaster leadership team.

The meeting took place in a large, rectangular room marked
NURSING RESOURCE CENTER
. White linoleum tables held a bank of computers normally used for training nurses. The computers were connected to the Internet and plugged into the red emergency outlets that operated off the generator system.

The room offered a sense of remove. Homey pink, pleated valances framed windows overlooking a courtyard enclosed by the reddish-brown tapestry brick of the old hospital building. There were mismatched sofas, brown cabinets, and a sink. The hospital’s chief financial officer, Curtis Dosch, had brought over a television set with a rabbit-ear antenna, placed it on a low table, and plugged it into a red outlet. Staff hunched down to peer at it, though it showed mainly static.

Susan Mulderick, Wynn’s longtime boss, ran the meeting. Wynn trusted Mulderick, who had hired her as a staff nurse when she started her career in the 1980s, then promoted her to manager when Wynn was pregnant and on bed rest. While others saw only the professional, intimidating Mulderick, Wynn knew inside she was a marshmallow, a cream puff. She had always set clear expectations and given Wynn the freedom and support she needed to meet them. Wynn adored Mulderick and admired her intelligence and creativity.

The command team announced a shift in hospital operations from “assault mode” to “survival mode.” This unofficial designation reflected news they had received minutes before the meeting. An Acadian
ambulance worker on-site had confirmed with his dispatchers that one of the canals in New Orleans had been breached. That meant water could be headed toward the hospital. Memorial’s workers might be exhausted, but they were beginning to realize that rather than signing out their patients to the returning “B” team and going home, they could be stuck at the hospital for a while.

Wynn and the other department heads checked in. Their reports were relatively upbeat. The hospital was functioning almost normally, in spite of the heat. Maintenance workers were picking up debris, taking down floodgates, and patching holes in the roof exposed when the wind ripped away ducts and flashing. Kitchen employees were handing out Styrofoam cups filled with scrambled eggs and bacon. (The sight of low-wage cooks tending the stoves in the swelter with tied-up hair and cut-off sleeves and scrub pants had awed one executive who came down to the kitchen seeking extra food for a patient. An employee turned and asked, “What you need, baby?” as if it were any other day.)

Feeding not only the patients but also everyone else, it was thought, might help calm the hundreds of family members and hospital neighbors who had taken shelter at Memorial and were getting antsy. With downed trees and power lines on the streets and reports of flooding only blocks away, it wasn’t safe for people to leave, though many were trying. Some headed to a darkened Winn-Dixie supermarket about eight blocks away and returned, arms laden with diapers, food, and drinks. One described this as “
soul surviving, surviving for the soul.” Others considered it looting.

After the meeting broke up, a memo went out to reinforce what the command team had decided: “Incident Command has declared Survival Mode for Memorial Medical Center.”

All staff and physicians were instructed to stay at the hospital. Family members were advised to stay too. The hospital could expect flooding. There would be no elective surgery and no MRIs, PET scans, or CTs.
Medically stable patients were to be discharged, even though they may not have had anyplace to go or any way of leaving. Some were taken to the lobby in wheelchairs to wait. The head pharmacist was still scrambling to arrange for a drop-off from his supplier to replace the dwindling stores of medicines.